Descemet-stripping automated endothelial keratoplasty by using suture for donor insertion

To describe a new technique for donor insertion in cases of Descemet-stripping automated endothelial keratoplasty (DSAEK).

This is a retrospective case series study of a novel method to introduce the donor tissue in DSAEK. This is a report of 16 cases that underwent the DSAEK procedure. The surgical technique consisted of stripping the Descemet membrane and endothelium from the recipient's central cornea and insertion of a posterior donor tissue with a double-armed 10-0 polypropylene, nonabsorbable suture, with a straight transchamber needle and a 1/2 circle needle. Follow-up was 1-12 months. Best spectacle-corrected visual acuity (BSCVA) was measured at 3, 6, and 12 months, and endothelial counts were measured up to 12 months after the surgery.

Sixteen consecutive patients underwent uncomplicated DSAEK. Three patients had known macular scar or glaucomatous optic nerve damage that precluded results of vision better than 20/200. Of the remaining 13 patients, 3 had BSCVA of 20/70 by the third month postoperative, 9 were 20/50, and 1 achieved 20/40. Nine were 20/40 or better at 1 year and the other 4 achieved 20/50. The average cell count after 1 year was 1950 cells/mm2.

Early outcomes in our initial series of cases of DSAEK using a suture to insert the donor suggest that the technique provides advantages related to endothelial cell loss. DSAEK allows more rapid BSCVA visual recovery than that usually found with penetrating keratoplasty.